Catheter ablation of macro-reentrant atrial tachycardia in adults with Ebstein anomaly: A narrative review

Improving survival rates of patients with Ebstein anomaly have increased the relevance of catheter ablation of macro-reentrant atrial tachycardia (MRAT). Our objectives were, first, to present a case report and, second, to provide a comprehensive review. A search of articles providing detailed information on adults with Ebstein anomaly who underwent catheter ablation of MRAT was performed. PubMed was queried using “Ebstein” and “ablation” as Medical Subject Headings terms, followed by a review of references and citations. Of the 56 patients included in the final review, which included the case report patient, 40 patients (71%) had only typical atrial flutter and 2 patients (4%) had left atrial involvement. The American Heart Association and American College of Cardiology Adult Congenital Heart Disease Anatomic and Physiological classification was not reported in any of the retrieved articles. Pre-procedural imaging localizing the coronary sinus ostium on the ventricular side of a tricuspid valve prosthesis may indicate the need to perform catheter ablation on the ventricular side to achieve bi-directional block across the cavotricuspid isthmus. Long-term recurrence of atrial tachyarrhythmias occurred in 6 of 23 patients (26.1%) where it was reported. In conclusion, catheter ablation is a viable option for adults with Ebstein anomaly and MRAT.